Patient access to personal health records via WebCIS has been known as a helpful factor that leads to greater patient empowerment over disease and health . It consequently improves self-directed disease management in patients particularly with chronic disease. The concept of empowerment has been investigated primarily in such fields as business, politics, and education . There was no common definition of “empowerment” utilized in all situations, because its manifestations varied in different contexts. Although empowerment is difficult to be defined as a single notion, Roberts mentioned that previous studies suggested the following three levels of empowerment: (1) individual or micro-level empowerment, which referred to a feeling of having control over one’s life. This was similar to self-efficacy, individual independence, or self-esteem; (2) community or mediating-level empowerment, which signified a group of individuals that shared knowledge to increase the level of psychological empowerment of members, a political action, or the fulfillment of decision-making favorable to the community; (3) organizational or macro-level empowerment, which indicated social or political activities in which individuals or groups participated. In particular, the community-level empowerment played a role in connecting individual and organizational empowerment.
While empowerment was a multi-level concept, research in health care settings focused mostly on micro-level empowerment, concerning how patients came to feel powerful . Traditionally, the source of patient empowerment was health care providers—through their education of patients, or via mutually active relationship between physicians and patients. However, patients could become empowered by other sources, such as support groups, or they could search for information on the Internet. Among the other sources, patients’ use of health information on the Internet was presumed to raise the level of patient empowerment. This hypothesis was based on the notion of “informed patients”—patients were said to become empowered and to challenge the asymmetrical physician-patient relationship via increased access to health information, particularly on the Internet .
This concept, however, was criticized mainly for two reasons. One involved the fact that there were several confounding factors affecting access to relevant health resources on the Internet; for example, socio-economic status, information literacy, or health literacy . The other concerned the argument that it was empirically difficult to sustain changes in the physician-patient relationship, on which the notion of informed patient was predicated. If physicians did not validate or approve of Internet information brought into clinical encounters, patients were still limited in participating in the treatment decision-making process. Also, not all patients brought Internet information to doctors, even if patients felt more control in their lives and of their disease via the access to the information. Patient empowerment thus was distinguishable into two types: (1) the process of personal transformation where power was “created within patients” (p. 15); (2) the process of communication between physicians and patients in which knowledge, values, and power were shared .
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Submitted by Ji-Hyun Kim